The Transportability and Utility of Cognitive Therapy in South African Contexts: A Review

Prolonged exposure therapy and supportive counselling for post-traumatic stress disorder in adolescents: task-shifting randomised controlled trial

BACKGROUND

Empirical evidence on the effectiveness of evidence-based treatments for adolescents with post-traumatic stress disorder (PTSD) in low-resource settings is needed.AimsTo evaluate the comparative effectiveness of prolonged exposure and supportive counselling in adolescents with PTSD.

METHOD

Sixty-three adolescents (13-18 years) with PTSD were randomly assigned to receive either of the interventions comprising 7-14 sessions of treatment (trial registration in the Pan African Clinical Trials Registry: PACTR201511001345372). The primary outcome measure was PTSD symptom severity, as independently assessed on the Child PTSD Symptom Scale at pre-treatment, post-treatment, and at 3- and 6-month follow-up.

RESULTS

Participants receiving prolonged exposure experienced greater improvement on the PTSD symptom severity scale than those receiving supportive counselling (between group differences at post-intervention, mean 12.49, 95% CI 6.82-18.17, P<0.001; d = 1.22). A similar effect size was maintained at 3-month (d = 0.85) and 6-month (d = 1.02) follow-up assessments.

CONCLUSIONS

Adolescents with PTSD experienced greater benefit from prolonged exposure treatment when provided by non-specialist health workers (nurses) in a community setting.Declaration of interestNone.

Prolonged exposure therapy and supportive counselling for posttraumatic stress disorder in adolescents in a community-based sample, including experiences of stakeholders: study protocol for a comparative randomized controlled trial using task-shifting

BACKGROUND

There is a dearth of empirical evidence on the effectiveness of pharmacological and non-pharmacological treatments for adolescents with posttraumatic stress disorder (PTSD) in developing countries. The primary aim of the study is to examine the effects of prolonged exposure therapy compared with supportive counseling for adolescents with PTSD delivered by nurses trained as counselors.

METHODS/DESIGN

A single-blind randomized clinical trial comprising 90 adolescents with PTSD using a permuted block design will be utilized. Nurses previously naïve to prolonged exposure and supportive counselling will be trained to provide these treatments at the adolescents' high schools. Data collection will last from March 2014 to December 2017 and annually thereafter, dependent on the availability of funding. Participants will receive seven to fourteen 60 min sessions of prolonged exposure treatment (n = 45) or supportive counselling (n = 45). All assessments will be conducted before treatment, at mid-treatment, immediately after treatment completion, at 3-, 6-, and 12-month follow-up, and annually thereafter. It is hypothesized that PE-A will be superior to SC in reducing PTSD symptoms at post-treatment as measured by the CPSS-I administered by an independent evaluator. It is further hypothesized that PE-A treatment gains will be maintained at 3-, 6- and 12-month follow-ups and annually thereafter.

DISCUSSION

While early indications are that PE-A is an effective treatment for PTSD in adolescents, this study will help determine the effectiveness of PE-A in a South African, community setting (school-based) when task-shifted to nurses, as compared to SC.

TRIAL REGISTRATION

Pan African Clinical Trials Registry: PACTR201511001345372 , retrospectively registered 11 November 2015.

The therapeutic relationship and Cognitive Behavioural Therapy: A case study of an adolescent girl with depression

The therapeutic relationship in Cognitive Behavioural Therapy (CBT) has been argued to play an essential role in positive outcomes in therapy. However, it is described as necessary and yet, secondary to technique, often receiving little attention in the training of CBT therapists. This case study explores a trainee psychologist’s experience of finding difficulty in feeling authentic and the application of CBT techniques with her client. This difficulty informed the research question; what is the value of the therapeutic relationship in CBT? A hermeneutic approach with a strong emphasis on phenomenology, is used to explore the therapeutic process and the therapeutic relationship that developed between therapist and client. Qualitative descriptions of 11 sessions are divided into themes, these are discussed in relation to what happened in therapy, and are then discussed further regarding discovery and process into the therapeutic relationship. Conclusions from this case study could possibly reveal the value of the therapeutic relationship when working from a CBT approach, and how it seemed to enable the client to achieve her goal in therapy.

Child and adolescent cognitive behaviour therapy in South Africa: An editorial review

The evidence base for cognitive behaviour therapy (CBT) (1) and other psychotherapeutic interventions in child and adolescent populations in low to middle income countries such as in South Africa is almost non-existent. In this review we explored the transportability of cognitive behaviour therapy interventions into the South African mental health care environment. Further investigations of CBT's effectiveness for children and adolescents and its cultural adaptability in South Africa are needed. (1)When using 'cognitive behaviour therapy' in this article we refer to all iterations and therapies that support the basic principles of CBT and that are evidenced based.

Clinical psychology training in South Africa: A call to action

With the profession of clinical psychology and its formal training programmes less than 40 years old in South Africa, it is important that efforts are made to critically examine its challenges and the extent to which it is meeting the prevailing mental health needs. The profession has gone through a chequered history in South Africa and needs to look at how it realigns its goals and practices, to be in tune with the imperatives of democracy, and to ensure that mental health benefits accrue to all of the country’s people, rather than a minority. To this end, the authors examine training issues, such as recruitment, curricula, and future directions. We assert that a clinical psychology that draws from current resources and foregrounds a primary health-care orientation can start to address some of the challenges facing training in South Africa.